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Alvi, Mohsin H., Shiri, Tinevimbo 
ORCID: https://orcid.org/0000-0002-9092-3268, Iqbal, Nasir, Husain, Mohammed Omair, Chaudhry, Imran, Shakoor, Suleman, Ansari, Sami, Kiran, Tayyeba, Chaudhry, Nasim and Husain, Nusrat
(2021)
'Cost-Effectiveness of a Culturally Adapted Manual-Assisted Brief Psychological Intervention for Self-Harm in Pakistan: A Secondary Analysis of the Culturally Adapted Manual-Assisted Problem-Solving Training Randomized Controlled Trial'. Value in Health Regional Issues, Vol 25, pp. 150-156.
Abstract
Objectives
Self-harm is a serious public health problem. A culturally adapted manual-assisted problem-solving training (C-MAP) intervention improved and sustained the reduction in suicidal ideation, hopelessness, and depression compared with treatment as usual (TAU) alone. Here, we evaluate its cost-effectiveness.
Methods
Patients admitted after an episode of self-harm were randomized individually to either C-MAP plus TAU or TAU alone in Karachi. Improvement in health-related quality-adjusted life years (QALYs) was measured using the Euro Qol-5D-3L instrument at baseline and at 3 months and 6 months after randomization. The primary economic outcome was health service cost per QALY gained as the incremental cost-effectiveness ratio, based on 2019 US dollars and a 6-month time horizon. Nonparametric bootstrapping was used to assess uncertainties, and sensitivity analysis to examine the impact of hospitalization costs.
Results
A total of 108 and 113 participants were enrolled among the intervention and standard arms, respectively. The intervention resulted in 0.04 more QALYs (95% confidence interval [CI] 0.00–0.08) 6 months after enrolment. The mean cost per participant in the intervention arm was US $1001 (95% CI 968–1031), resulting in an incremental cost of the intervention of US $640 (95% CI 595–679). The incremental cost-effectiveness ratio for the C-MAP intervention versus TAU was US $16 254 (95% CI 7116–99 057) per QALY gained. The probability that C-MAP is cost-effective was between 66% and 83% for cost-effective thresholds between US $20 000 and US $30 000. Cost-effectiveness results remained robust to sensitivity analyses.
Conclusions
C-MAP may be a valuable self-harm intervention. Further studies with longer follow-up and larger sample sizes are needed to draw reliable conclusions.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WM Psychiatry > WM 100 General works WM Psychiatry > WM 20 Research (General) |
| Faculty: Department: | Clinical Sciences & International Health > International Public Health Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1016/j.vhri.2021.02.006 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 02 Sep 2021 09:03 |
| Last Modified: | 02 Sep 2021 09:03 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/18805 |
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